Blood Cultures Versus Respiratory Cultures: 2 Different Views of Pneumonia
Blood Cultures Versus Respiratory Cultures: 2 Different Views of Pneumonia
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DOI：
10.1093/cid/ciz1049
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发表时间：
2020-10-01
影响因子：
11.8
通讯作者：
Rothberg, Michael B.
中科院分区：
文献类型：
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作者：
Haessler, Sarah;Lindenauer, Peter K.;Rothberg, Michael B.
背景肺炎经验性治疗的选择取决于抗生素耐药性的风险。预测耐药性的模型来自血液和呼吸道培养结果。我们比较了这些结果，以了解不同地点的微生物和耐药性模式是否不同。我们还比较了患者的特点和结果与阳性文化的网站。我们研究了2010年7月至2015年6月从177家美国医院出院的成人患者，主要诊断为肺炎，或主要诊断为呼吸衰竭、急性呼吸窘迫综合征、呼吸骤停或败血症，次要诊断为肺炎，并进行了血液或呼吸道培养。对患者的人口统计学、治疗、微生物学结果和预后进行了检查。在138561例入院时获得血液或呼吸道培养的肺炎患者中，12888例（9.3%）获得阳性培养：6438例呼吸道培养，5992例血液培养，458例呼吸道和血液培养。42%的人对社区获得性肺炎的一线治疗有耐药性。呼吸道标本分离株的耐药率高于血液分离株（54.2% vs 26.6%; P <0.001）。两个培养部位均阳性的患者比仅血液或呼吸道培养阳性的患者有更高的病死率、更长的住院时间和更高的费用。在呼吸道培养中，最常见的病原体是金黄色葡萄球菌（34%）和铜绿假单胞菌（17%），而血培养中最常见的是肺炎链球菌（33%），其次是S。金黄色葡萄球菌（22%）。呼吸道培养阳性的患者在临床上与血培养阳性的患者不同，耐药模式因来源而异。抗生素耐药模型应考虑培养物来源。
Background. Choice of empiric therapy for pneumonia depends on risk for antimicrobial resistance. Models to predict resistance are derived from blood and respiratory culture results. We compared these results to understand if organisms and resistance patterns differed by site. We also compared characteristics and outcomes of patients with positive cultures by site.Methods. We studied adult patients discharged from 177 US hospitals from July 2010 through June 2015, with principal diagnoses of pneumonia, or principal diagnoses of respiratory failure, acute respiratory distress syndrome, respiratory arrest, or sepsis with a secondary diagnosis of pneumonia, and who had blood or respiratory cultures performed. Demographics, treatment, microbiologic results, and outcomes were examined.Results. Among 138 561 hospitalizations of patients with pneumonia who had blood or respiratory cultures obtained at admission, 12 888 (9.3%) yielded positive cultures: 6438 respiratory cultures, 5992 blood cultures, and 458 both respiratory and blood cultures. Forty-two percent had isolates resistant to first-line therapy for community-acquired pneumonia. Isolates from respiratory samples were more often resistant than were isolates from blood (54.2% vs 26.6%; P < .001). Patients with both culture sites positive had higher case-fatality, longer lengths of stay, and higher costs than patients who had only blood or respiratory cultures positive. Among respiratory cultures, the most common pathogens were Staphylococcus aureus (34%) and Pseudomonas aeruginosa (17%), whereas blood cultures most commonly grew Streptococcus pneumoniae (33%), followed by S. aureus (22%).Conclusions. Patients with positive respiratory tract cultures are clinically different from those with positive blood cultures, and resistance patterns differ by source. Models of antibiotic resistance should account for culture source.